‘The development sector is a graveyard of pilot projects!’ Six critical actions for externally funded implementers to foster scale-up of maternal and newborn health innovations in low and middle-income countries

Spicer, Neil; Hamza, Yashua; Berhanu, Della; Gautham, Meenakshi; Schellenberg, Joanna; Tadesse, Feker; Umar, Nasir; Wickremasinghe, Deepthi

doi:10.1186/s12992-018-0389-y

Cited by 33 publications

(34 citation statements)

References 22 publications

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“…Future implementation and research on MPDSR may also benefit from considering the vast literature more broadly on adaptability and sustainability in development ( Bopp et al. 2013 ; Spicer et al. 2018 ; Zamboni et al.…”

Section: Discussionmentioning

confidence: 99%

Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors

Kinney

Walugembe

Wanduru

et al. 2021

Health Policy and Planning

137

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Maternal and perinatal death surveillance and response (MPDSR), or any form of maternal and/or perinatal death review or audit, aims to improve health services and pre-empt future maternal and perinatal deaths. With expansion of MPDSR across low- and middle-income countries (LMIC), we conducted a scoping review to identify and describe implementation factors and their interactions. The review adapted an implementation framework with four domains (intervention, individual, inner and outer settings) and three cross-cutting health systems lenses (service delivery, societal and systems). Literature was sourced from six electronic databases, online searches and key experts. Selection criteria included studies from LMIC published in English from 2004 to July 2018 detailing factors influencing implementation of MPDSR, or any related form of MPDSR. After a systematic screening process, data for identified records were extracted and analysed through content and thematic analysis. Of 1027 studies screened, the review focuses on 58 studies from 24 countries, primarily in Africa, that are mainly qualitative or mixed methods. The literature mostly examines implementation factors related to MPDSR as an intervention, and to its inner and outer setting, with less attention to the individuals involved. From a health systems perspective, almost half the literature focuses on the tangible inputs addressed by the service delivery lens, though these are often measured inadequately or through incomparable ways. Though less studied, the societal and health system factors show that people and their relationships, motivations, implementation climate and ability to communicate influence implementation processes; yet their subjective experiences and relationships are inadequately explored. MPDSR implementation contributes to accountability and benefits from a culture of learning, continuous improvement and accountability, but few have studied the complex interplay and change dynamics involved. Better understanding MPDSR will require more research using health policy and systems approaches, including the use of implementation frameworks.

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Section: Discussionmentioning

confidence: 99%

Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors

Kinney

Walugembe

Wanduru

et al. 2021

Health Policy and Planning

137

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“…Woltering et al (2019) underscored the fact that agricultural innovations, such as improved seed, better management systems and practices, and collaborations need to be tested at pilot scale, and once successful, they must be scaled-up to address the envisioned size of the problem. However, in the case of milkfish farming in Kenya, most projects never scale-up to achieve the expected impact, since support ends after the demonstration phase (Cooley and Howard, 2019;Spicer et al, 2018). This could be associated with the fact that the number of donors and projects has doubled, while the project terms and budgets have significantly reduced in the last decades (Cooley, 2018).…”

Section: History Of Milkfish Farming In Kenyamentioning

confidence: 99%

Small-scale milkfish (Chanos chanos) farming in Kenya: An overview of the trends and dynamics of production

Mirera

2019

West Ind. Oc. J Mar. Sci.

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A number of donor-funded projects by NGOs, government departments and faith-based organizations have piloted milkfish farming along the coast of Kenya at different scales with the aim of addressing poverty and food security at the community level. This paper provides an overview of the history of milkfish farming, organisation of operations, funding, farmers trends, and production dynamics, using both secondary and primary data. Primary data were obtained from quantitative and qualitative assessments covering 26 community milkfish farming groups, while secondary data were obtained from the grey literature and donor-funded project reports. Additional primary data were obtained through 9 key informant interviews covering three coastal Counties, and focus group discussions (8-10 members) at all the community milkfish farms. The study established that milkfish farming could be traced back to the early 1980’s as a by-product of the prawn farming intervention by FAO, and later in other private farms that practised prawn farming. Community/village based small-scale milkfish farming was initiated about two decades ago using organised community groups (OCGs) as the entry point. The number of OCGs undertaking milkfish farming fluctuated with availability of donor funds and increased significantly between 2007 and 2015 with an increase in earthen pond farming area from 0.9ha to 6.8ha over this period. However, the scale of production remained low. Annual milkfish production increased from less than 50kg in 2005 to a maximum of 3.2 tons in 2015. Milkfish farming has not attained production levels that can address poverty and food security issues; a fact that was associated with the lack of reliable milkfish seed for stocking culture facilities. Harvests from existing farms are sold at the farm gate and in nearby market centres with a few communities venturing into opening fish shop outlets to sell their produce.

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“…Especially in the context of Tajikistan’s historical legacy of vertical, centralized structures, the institutionalization of Business Plans is crucial. Mirroring our findings that the governmental adoption of Business Plans enables the large scale implementation of the tool, studies conducted in Ethiopia, India and Nigeria have emphasized that government ownership of an innovation can support scaling up because governments have the legitimacy and resources to foster this process [ 18 , 30 ]. Advocacy is another effective tool to involve governmental actors or policy champions and to influence decision-making [ 12 , 21 , 22 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Often, donor funded projects in global health are limited in scale and have difficulties going to scale when donors exit the project [ 30 , 32 ]. In Tajikistan, where the health system is mainly vertically structured and a significant amount (8.22% in 2017) of total expenditure on health is provided by external resources [ 7 , 33 ], the exit of donors poses a serious challenge to sustain Business Plans in the future.…”

Section: Discussionmentioning

confidence: 99%

Scaling up Business Plans in Tajikistan: a qualitative study of the history, barriers, facilitators and lessons learnt

Werner

Afandiyeva²,

Karimova³

et al. 2021

Global Health Action

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Background To improve health planning at primary health care (PHC) level, Business Plans were introduced in Tajikistan by the Enhancing Primary Health Care (EPHC) Services Project. Objective To describe the history and process of implementation of Business Plans and to identify barriers, facilitators and lessons learnt from scaling up Business Plans. Methods Set in a qualitative research design, we conducted a desk review of project and official documents and seventeen semi-structured interviews with key stakeholders at national and sub-national levels between May and July 2020. We used an interview guide informed by the ExpandNet/WHO framework and analyzed the data following a content analysis approach facilitated by MAXQDA. Results With the participation of various user organizations and resource teams and through a variety of strategic scale-up choices, Business Plans have been scaled up from a vertical pilot project to institutionalized health management tools covering 45% of Tajikistan’s PHC facilities. The most prominent facilitators for scaling up Business Plans were the institutionalization and integration of the tool into the Tajik health system, the close collaboration with Community Health Teams (CHTs), the high acceptance of the tool among the users, the advocacy through champions and policy-makers and the large dissemination network. The most outstanding barriers to scaling up Business Plans were insufficient financial or human resources, general weaknesses in health governance, the lack of a strategic scale-up plan and strategic decisions, the lack of motivation or overall vision to implement Business Plans at a large scale and difficulties in donor coordination. Conclusion To ensure the continuity of scaling up Business Plans, developing a scale-up strategy, strengthening cross-sectoral collaboration and participation during scaling up, and capacitating the user organizations of Business Plans are important next steps to ensure the sustainability and effectiveness of Business Plans in the future.

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‘The development sector is a graveyard of pilot projects!’ Six critical actions for externally funded implementers to foster scale-up of maternal and newborn health innovations in low and middle-income countries

Cited by 33 publications

References 22 publications

Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors

Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors

Small-scale milkfish (Chanos chanos) farming in Kenya: An overview of the trends and dynamics of production

Scaling up Business Plans in Tajikistan: a qualitative study of the history, barriers, facilitators and lessons learnt

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